Systemic lupus erythematosus (SLE) is a debilitating autoimmune disease. Patients with SLE manifest various immunological abnormalities which probably reflect the immunopathological processes occurring concurrently in this multi-system disease. One consistent finding appears to be defective IL-2 production by peripheral blood T-lymphocytes which is independent of age or overall disease activity (Alcocer-Varela and Alarcon-Segovia, J. Clin. Invest. (1982), 69, 1388; Linker-Israeli, et al., J. Immunol. (1983), 130, 2651; Murakawy, et al., ibid (1985), 134, 187). The precise pathological significance of this is unknown. The administration of IL-2 in the murine lupus-like model MRL/lpr attenuated the autoimmune disease (Gutierrez-Ramos, Nature (1990), 346, 27). The sex hormone status of patients with SLE suggests that there is a relative deficiency of androgens (Jungers, et al. Arthritis Rheum. (1982), 25, 454; Lahita, et al. ibid (1983), 26, 1517). The administration of the androgen Danazol to patients with SLE, based on the proposition that there may be a protective effect conferred by androgens, has produced variable benefits with respect to disease activity and autoantibody production (Steinberg, et al., Arthritis Rheum. (1979), 22, 1170; Roubinian, et al., ibid (1979), 22, 1399).
Dehydroepiandrosterone (DHEA) is a natural androgen that is an intermediate in the synthetic pathway of cholesterol to testosterone and it is the most abundant secretory product of human adrenal glands (Vande Wiele, et al. Recent Prog. Horm. Res. (1963), 19, 275). About 30 mg/day of DHEA is produced by the adrenal glands in the form of the inactive sulfate ester and DHEA serum levels show a striking age-related decline (Barrett-Connor, et al. New Engl. J. Med. (1986), 315, 1519). DHEA has up-regulatory effects on IL-2 production by stimulating human T-cells in vitro. In the NZB/W mouse DHEA was found to profoundly delay the appearance of anti-DNA antibodies as well as the onset of nephritis and to prolong life (Lucas, et al. J. Clin. Invest. (1985), 75, 2091). There have also been reports that the administration of DHEA to MRL/lpr mice with severe lupus-like disease resulted in dramatic reversal of disease activity.
There is, therefore, substantial interest in evaluating the use of DHEA or derivatives thereof as a medication for the treatment of SLE in humans, by itself or in combination with other drugs.
Relevant Literature
Regelson, et al., Ann. N.Y. Acad. Sci. (1988), 521, 260-273 provides a review of DHEA properties and uses. U.S. Pat. No. 4,628,052 claims the use of DHEA in the treatment of arthritis.